Healthcare Provider Details

I. General information

NPI: 1194645499
Provider Name (Legal Business Name): LAMISHA MADISON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 BUNKER HILL RD
BELLEVILLE IL
62221-5766
US

IV. Provider business mailing address

344 BUNKER HILL RD
BELLEVILLE IL
62221-5766
US

V. Phone/Fax

Practice location:
  • Phone: 618-704-9873
  • Fax:
Mailing address:
  • Phone: 618-704-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number150109492
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: